Felt the Heat recently? Learn about heat injury and how to avoid "overheating"!

With the hotter and drier days over the past couple months, we have seen more patients coming in to our clinic with heat-related complications such as mild dehydration, headaches, skin rashes, and worsening gastroenteritis and viral illnesses due to dehydration.


With the hotter and drier period expected to continue over the next few months, we expect to see more heat-related complications and hence we want to share with you how to avoid "overheating"!


For those complications (heat stress, heat stroke, dehydration), what are the immediate treatments provided?


Heat injury is the broad umbrella of such illnesses. Early recognition of heat injury, is absolutely critical in the management and treatment. A change in the mental status of a casualty is a key manifestation of heat stroke.

As a bystander, if you see someone who is suspected to have "heat stroke", to assess mental status, the AVPU scale can be used.

A - alert

V - casualty responds only to verbal stimulus

P - casualty responds only to pain

U - unresponsive

To assess, one should ask these 3 questions to someone who is possibly having heat injury:

What is your name?

What time is it now (roughly)?

Where are we now (roughly)?


If the patient is not 100% alert, or is unable to respond to any of these 3 questions, it is likely that the patient is having an altered mental status, which is a key manifestation of heat stroke or at least, moderate heat injury. Promptly, the bystander should call 995 for prompt assistance. This is most important especially in public outdoor exercise facilities like stadiums, exercise areas, water canoeing areas, parks when the public is exercising, and already under thermal stress.

Whilst waiting for the ambulance, if possible, one should start trying to cool the casualty down. Some of the immediate treatments can include: 1. Immerse the arms in ice water if possible

2. Removal of clothing and cool the casualty

3. Do not crowd round the casualty as this would impede wind flow and increase thermal stress.

Credit to Singapore Armed Forces - Ice Water Arms Immersion Technique
Credit to Singapore Armed Forces - Ice Water Arms Immersion Technique

If the patient is still alert and verbally responsive, and does not need emergency 995 assistance, one should still go to see a doctor for assessment.


How can we prevent and safeguard against heat-related risks?


Firstly, be aware that heat injuries can and will happen.

Early recognition of heat injury is absolutely critical in the management of heat injury. Most of the time, it is the failure to recognize the signs that result in poor outcome for the casualty.


To reduce one’s rate of heat injury, we can do the following:

  1. Zero or low alcohol intake 24 hours prior to intensive exercise.

  2. If recovering from any viral infections, do not be a “hero” and try to resume intensive exercise immediately. Instead, wait till fully recovered then resume light exercise.

  3. Rest well, at least 7 hours of uninterrupted sleep prior to exercising

  4. Caffeine is a diuretic, which means coffee will predispose one to peeing more and hence, may predispose one to dehydration. Not a good idea prior to exercise.

  5. During exercise, or activities that are prolonged in the heat, one should drink adequate fluids, water, or even better, isotonic drinks that have appropriate salt content.

  6. See a doctor if suspecting mild dehydration

  7. Call 995 immediately if any altered mental state is detected in a casualty as early intervention of heat injury can and will save lives.

Most importantly, drink LOTS of Fluids to stay COOL in the heat!



References:

Singapore doctors caution against heat related health risks as the mercury rises https://www.straitstimes.com/singapore/health/singapore-doctors-caution-against-heat-related-health-risks-as-mercury-rises

Fact Sheet on Purpose Built Cooling Pads and Arm Immersion Cooling System - Singapore Armed Forces, https://www.mindef.gov.sg/web/portal/mindef/news-and-events/latest-releases/article-detail/2018/august/06aug18_fs

SAF Implements Additional Heat Injury Prevention Measures https://www.mindef.gov.sg/web/portal/pioneer/article/feature-article-detail/ops-and-training/2018-Q3/sep18_fs3

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